Background and objective. Knowledge of local antimicrobial resistance pattern is very important for evidence-based empirical antibiotic prescribing. The main objective of the present study was to evaluate the prevalence and the antimicrobial resistance pattern of the main bacteria responsible for uncomplicated urinary tract infection (UTI) in Kyiv region (Ukraine), throughout a ten year period, in order to establish an appropriate empirical therapy. Materials and methods. A retrospective analysis of the etiological spectrum and antimicrobial resistance of uropathogens in urine samples isolated over the 10-year period, 2005 to 2015, in a single center was performed. Results. In total 380positive urine samples processed at our laboratory of which 193/380 (51 %) had E. coli as the infecting organism. Although E. coli was, as usual, the most common pathogen implicated in UTI, it were observed increasing the share of Enterococcus spp. - 82/380 (21.6%). Ampicillin and trimethoprim were the least-active agents against E. coli with resistance rates of 75% and 70%, respectively. Significant trends of increasing resistance over the 10-year period were identified for trimethoprim, fluoroquinolones ІІ and III generations, penicillins, and carbapenems. Nitrofuran derivative remains a reasonable empirical antibiotic choice in this community with a 10-year resistance rate of 8.3 %. Was determined that recurrent UTI is an independent risk factor for bacterial multidrug-resistance. Conclusions. Over the last 10 years, the proportions of fluoroquinolones resistant E. coli and multidrug-resistant bacteria have significantly increased. The fluoroquinolones shall not be used in the empirical treatment of uncomplicated UTI in Kyiv region patients. For the empirical treatment of uncomplicated UTI in women should be used nitrofuran derivative (furazydyn K). If required of parenteral administration of antibiotics should be used cephalosporins IVgeneration. This data will enable evidence-based empirical prescribing which will ensure more effective treatment and lessen the emergence of resistant uropathogens in the community.

Bacterial infections in chronic kidney disease stage VD (CKD VD st.)patients are associated with increased risk of hospitalization and death.   The aim was to study of opportunistic pathogenic bacteria spectrum, their antibacterial resistance and the correlation between carriage and hospitalization and mortality rate in adult patients with CKD V D st. Materials and methods. This prospective cohort, open-label, randomized, two-phase study included 146 patients with CKD V D st., 118 of whom were treated by hemodialysis (HD) and 28 by peritoneal dialysis (PD). The microbiological screening was conducted in the first stage. The examined material was throat/nose swabs and wet smears from skin of dialysis access site. On the second stage all patients were randomized on two groups: the group 1 (n=61) included patients with identified MRSA / VRE colonization and group 2 (n=85) included patients with colonization of other strains of opportunistic pathogenic bacteria. The groups were representative according to gender, age, type of kidney affections and renal replacement therapy (RRT) modality. The microbiological examination consisted of inoculation of hard medium by examined material. The end points were total amount of hospitalization and death events evaluated for 24 months after randomization. Results. The colonization of some biotype of opportunistic pathogenic bacteria was established in 100% ofpatients. In total were isolated 347 strains of gram-positive bacteria: 284 and 63 in HD and PD patients, respectively. Without statistical significance approximately 20% of microorganism strains were resistant to 10 and more antibiotics according to dialysis modality. The MRSA colonization was identified in 49 (33.6%) patients (37/31.4% and 12/42.9% of HD u PD patients, respectively; p=0,246). The VRE colonization was established in 12 patients (10/8.5% and 2/7.1% of HD and PD patients, respectively; p=0.81). The 70 hospitalization episodes were recorded during monitoring period. The significant majority was established in group 1 of patients (39/64% vs. 31/36.5 %; %2 =10.733, p=0,001) irrespective ofRRTmodality. The specific share ofdead persons in group 1 was in three times more than such share in group 2 (9/14.8% vs. 4/4.7 %; %2=4.42, p= 0.0355). The relative risks of hospitalization and death in the presence of MRSA/VRE colonization increased in 1.75 (95% CI: 1.252.5) and 3.14(95% CI: 1.01-9.7) times. Conclusion. In this study was demonstrated that MRSA/VRE colonization in adult patients with CKD V D st. is a risk marker and a predictor of negative clinical prognosis. The RRT modality hadn’t significant effect on rate of negative consequences, particularly on rate of hospitalization and death in population of CKD V D st. patients.

The article presents the analysis of the native and foreign literature data and also the results of our own research devoted to studying the role of herpes virus infection in the appearance and course of glomerulonephritis in children. There has been described pathogenesis and clinical aspects of virus associated glomerulonephritis in children. Much attention has been paid to the diagnostic methods of herpes virus infection in glomerulonephritis. The importance of association of immunosuppressive and antiviral therapy has been underlined.

Ключові слова: хронічний рецидивуючий пієлонефрит, збудники, механізми персистенції. Key words: chronic recurrent pyelonephritis, pathogens, mechanisms of persistence. Резюме. Целью данной работы была сравнительная оценка видового спектра бактериальных возбудителей хронического рецидивирующего пиелонефрита при лонгитудинальном исследовании. Материалы и методы. Проведены комплексные микробиологические исследования мочи, соскобов из цервикального канала и вагинальных мазков 386 женщин, больных хроническим пиелонефритом. Результаты исследования. Анализ спектра микрофлоры, выделенной из мочи больных на протяжении 10 лет, выявил существенный рост удельного веса Enterococcus spp. (до 18,6 %). В процессе рецидивирования хронического пиелонефрита у 64,3 % больных выявлены изменения спектра возбудителей с преобладанием E.faecalis та S.epidermidis (по 14,3 %). Параллельно установлено наличие условно-патогенной микрофлоры у обследованных женщин в вагинальных мазках (40,1 %) и соскобах из цервикального канала (30,8 %). Рассмотрены механизмы персистенции бактерий в мочеполовых путях у женщин, страдающих хроническим рецидивирующим пиелонефритом.Заключение. Подчеркнута важность всестороннего изучения спектра и свойств возбудителей, обуславливающих обострения хронического пиелонефрита, и механизмов течения заболевания.Summary. The aim of this work was to compare the specific spectrum of bacterial pathogens which stipulate chronic recurrent pyelonephritis during the longitudinal following-up.Materials and methods. There were performed the complex microbiologic investigations of urine, scrapes from cervical canal and vaginal smears from 386 women with chronic pyelonephritis.Results. The analysis of the spectrum of microflora separated out of the patients' urine during 10 years showed the considerable growth of the specific weight of Enterococcus spp. (up to 18,6 %). In the process of chronic pyelonephritis recurrence in 64,3 % patients showed the changes in the specific spectrum of pathogens with the prevalence of E. faecalis and S.epidermidis (14,3 % each). At the same time, there was stated the presence of opportunistic microflora in vaginal smears (40,1 %) and scrapes from cervical canal (30,8 %) of the examined women. The mechanism of bacteria persistence in urogenital tracts in women with chronic recurrent pyelonephritis was also under study.Conclusion. There has been confirmed the importance of the comprehensive study of the spectrum and specificity of pathogens which can stipulate the aggravation of chronic pyelonephritis and mechanisms of its course.

The aim of our study was to determine the effectiveness of Sodium nucleinate in treatment of patients with recurrent pyelonephritis. Material and methods. This clinical study is a prospective, open, controlled, randomized clinical study. Two types of therapies were evaluated in parallel groups. 98patients with recurrent pyelonephritis were examined in the dynamics of treatment. We investigated the state of the genitourinary system microbiota, mucosal immunity performance of the urogenital tract and contents of blood cytokines. After the examination the patients were divided by the applied therapeutic approach. The first group of the women (n=55) received antibiotic therapy and Sodium nucleinate 0.25 g 4 times per day for 2 weeks. The second group of the women (n=43) received only antibiotics. Results. The frequency of eradication of U. urealyticum (including in association with M. hominis) was significantly higher in patients of the first group. We have identified a significantly higher phagocytic activity and a phagocytosis intensity of neutrophils in samples from the vagina in women of the first group (46 [28-49] vs 17 [13-27.5] p = 0.002 and 3.19 [2.34-4.9] against 2.8 [1.23-3.6] p=0.02, respectively).The study of mucosal immunity has demonstrated a significant decrease the content of lactoferrin and increasing sIg A in the urine of patients of group (6.85 [0.2-80] vs 0 [0-0.4] ng/ml, p=0.01 and 0.42 [0-0,7] vs. 3.2 [0-3,7]g/ml, p=0.04, respectively).In addition, the use of Sodium nucleinate promoted to a significant reduction of high levels of all investigated cytokines: IL-4 (p=0.003), IL-17 (p=0.005), NGAL (p=0.02), TNF-$ (p=0.02) and MCP-1 (p=0.03). In the control group was achieved just the reduction in levels of IL-4 (p=0.007) and IL-17 (p=0.04). Conclusions. Thus, the application of the proposed therapies can improve the effectiveness of the treatment of patients with recurrent pyelonephritis by normalization of mucosal immunity of the genitourinary system and the cytokine profile. We believe that the traditional antibiotic therapy ofpatients with recurrent pyelonephritis advisable to supplement of Sodium nucleinate at a dose of 0.25g 4 times / day for 2 weeks.